Sinus Communication with Extraction Grafting


If you are a regular reader of this blog you have heard me talk about ‘Tooth Replacement Therapy’ multiple times.  It’s not me trying to be fancy and trademark something (I’m pretty sure I first heard the saying from Dr. Mike DiTolla), but instead, it’s my way of shifting your mindset on treatment planning and case presentation.

Basically, in ‘Tooth Replacement Therapy’ you go ahead and make a treatment plan and financial arrangements for the entire process from start to finish.

Pamela was seen in our office for a consultation (second opinion) for her upper right.  She was not having acute pain but has noticed some drainage from the gums above a tooth.  Her previous dentist advised her she needed teeth ## 2, 3, and 4 removed due to infection and decay.

Pam wants to save her teeth and didn’t like the sound of the plan from the previous practice.

Below is the 3D CBCT slice of the area in question.  I gave Pam the not so good news – that I absolutely agreed with her previous treatment plan.

3D CBCT was taken during the consultation of the upper right area

The main difference between my plan and the previous plan was a couple of things:

  1. I used advanced visual ‘proof’ (3D vs 2D) to help her see what I was seeing.
  2. I gave her hope by talking about the outcome – I didn’t focus on the extractions but instead giving her back her teeth using dental implants.
  3. I laid out a complete game plan from start to finish – not just the tooth extraction phase.

Some times you simply have to slow down to speed up!

Case Photos

Handling Sinus Communication 

I am no expert on sinus pathology.  But here is how I handled this particular case.

  • I placed the patient on over the counter decongestant at a consultation prior to surgery.
  • At the surgery appointment, we did a bolus dose of Antibiotics and 4mg dexamethasone.
  • During surgery, we verified no additional exudate was coming from sinus communication and a folded over collagen membrane was placed over the ‘hole’.

The Sales Pitch

Are you wanting to do more advanced clinical cases like this?  Then I have some suggestions.

  1.  Digital Implant Continuum – In this LIVE PATIENT workshop you are walked through the fundamental concepts used in this case for extraction with site preservation and the subsequent implant dentistry.
  2. B1 – Foundational Case Acceptance – In this 1-day seminar you are walked through how to gain case acceptance by having a proven buying process for your patients.
  3. B2 – Multi-Disciplinary Treatment Planning & Case Sequencing – This new program (coming in 2021) will be a 2-day hands-on program on planning, sequencing, and executed multi-disciplinary cases.

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